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Affiliation
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Department of Pulmonary and Critical Care Medicine, Thomas Jefferson University, 1015 Chestnut Street, Suite M-100, Philadelphia, PA 19107, USA; Division of Thoracic Surgery, Pennsylvania Presbyterian Medical Center, USA |
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Abstract
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A 37-year-old female presented to pulmonary clinic for evaluation of exertional dyspnea and cough. Nine months before presentation she was involved in motor vehicle accident as a driver. During the accident the driver side airbag deployed and ruptured. Hours after the accident, the patient experienced airway irritation and cough. As a result of the accident, she sustained back injury that required surgical intervention. Seven months before presentation, after recovery from surgery, she noticed shortness of breath with resumption of daily activities. Four months before presentation, she was evaluated in an emergency department for worsening dyspnea and cough and received treatment. She noticed only transient and minimal improvement in her symptoms. She was a lifelong non-smoker and had no known occupational exposures.
Upon opur evaluation, a computed tomography (CT) of the chest was performed that revealed patchy bilateral ground-glass infiltrates and consolidations. These findings suggest interstitial and alveolar inflammation.
Dry cough, dyspnea on exertion, restrictive physiology, and diffuse ground-glass infiltrates on CT scan is characteristic of interstitial lung disease (ILD). A lung biopsy was obtained by video-assisted thoracoscopy surgery (VATS). Pathologic examination of lung biopsy showed nonspecific interstitial pneumonitis (NSIP) pattern. Differential diagnosis of NSIP pattern includes: pneumonitis secondary to autoimmune disorders, inhalation-induced lung injury, drug reactions, and hypersensitivity pneumonitis. Detailed history, physical examination, and extensive laboratory investigation excluded hypersensitivity pneumonitis and autoimmune-related ILD. Idiopathic interstitial pneumonitis with NSIP pattern is a rare entity and although idiopathic NSIP can not be excluded, we believe clinical course, symptoms, and pathologic findings can be best explained by exposure and inhalation of toxic components of the airbag.
Frontal airbags are held to have saved almost 14,000 lives between 1987 and 2003. Airbags on both the driver and passenger sides have been required in all new cars manufactured after September 1997. In purely frontal crashes, airbags reduce the fatality risk by 34%. Nevertheless, several different types of injury are attributed to airbag deployment and, occasionally, to its rupture. Asthmatic reactions, reactive airway dysfunction syndrome (RADS) due to sodium azide (propellant for the inflation of airbags) inhalation, and bilateral pneumothorax in the absence of associated chest trauma have been reported as a consequence of airbag deployment and/or rupture. To the best of our knowledge, however, there are no reported cases of parenchymal lung disease associated with airbag deployment and/or rupture.
Automobile airbags are designed to inflate upon sudden deceleration. The bag itself is made of a thin, nylon fabric that is folded into the steering wheel or dashboard. When there is a collision force equal to running into a brick wall at 10 |